| Summary: | Degree: Master of Science Abstract: Tuberculosis (TB) incidence in the Indigenous people of Canada continues to be disproportionately higher than that of the non-Indigenous and foreign-born people. For more than a decade, the rate of TB in the Indigenous people of Canada has remained relatively constant despite recent population growth. Most researchers have speculated that demographic and geographic risk factors along with the colonially and historically rooted poor social circumstances are associated with the ongoing transmission in the Indigenous people, thus raising concerns for TB control efforts. This thesis combined conventional and molecular DNA fingerprinting of Mycobacterium tuberculosis isolates to (1) identify and describe the demographic and geographic characteristics of all transmission events from Canadian-born pulmonary TB cases on the Prairie Provinces in 2007 and 2008; and (2) describe the predictors of new infection and secondary cases based on host, environmental, and behavioral characteristics of the transmitters. We found that transmission was most common from Registered First Nations potential transmitters who resided in reserve communities. Recent infection was slightly higher in contacts with reportedly lower exposure to the transmitter, but active disease was most notable in the infected close contacts. A significant proportion of transmission events suggested extensive geographic mobility between the residence of transmitters and their contacts, which poses a considerable challenge to jurisdictionally contain TB transmission. Upon further investigation, the likelihood of observing a transmission event was significantly greater in transmitters with advanced stages of pulmonary disease and in those that resided in households with poor ventilation. In light of these findings, it is clear that provincial TB control programs must strive to prioritize the demographic, geographic, clinical, and social determinants in the Indigenous people of the Prairies. Collaborative effort of healthcare ...
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